经颅电刺激运动诱发电位和皮层体感诱发电位在脊柱侧凸手术中联合监护的观察研究

目的 探讨脊柱侧凸手术中经颅电刺激运动诱发电位(transcranial electrical stimulation motor evoked potential,TES-MEP)和皮层体感诱发电位(cortical somatosensory evoked potential,CSEP)联合监护的可行性和应用价值.方法 2006年7月至2008年4月,在脊柱侧凸手术中同时记录双侧胫前肌、足(足母)短屈肌TES-MEP和双侧胫后神经CSEP 76例.实施全静脉麻醉49例,七氟烷(吸入浓度＜1%)+异丙芬复合麻醉27例.对各麻醉组的TES-MEP检出结果 进行四格表χ2检验,并对术中两种电位的真、假阳性和真、假阴性结果 进行相关的指数统计分析.结果 TES-MEP和CSEP成功检出率均为96.1%,而两种麻醉组的TES-MEP检出率差异无统计学意义.术中诱发电位阳性11例,其中9例为真阳性,均与手术操作不当直接有关.CSEP、TES-MEP、联合监护的灵敏度分别为75.0%、87.5%和100%,特异度分别为98.5%、98.5%和97.0%,约登指数分别为0.74、0.86和0.97.结论 实施异丙芬静脉麻醉为主,辅以七氟烷吸入浓度＜1%的复合麻醉,也是联合监护切实町行的麻醉方案;联合监护对脊髓功能监测的敏感性和准确性明显高于单一的TES-MEP或CSEP监护.

Observation of combined application of TES-MEP and CSEP monitoring during the surgery of scoliosis

Objective To investigate the feasibility and applied value of transcranial electrical stimulation motor evoked potential (TES-MEP) combined with cortical somatosensory evoked potential (CSEP) monitoring during the surgery of scoliosis.Methods From July 2006 to April 2008, 76 patients were simultaneously recorded the TES-MEP on bilateral anterior tibial muscle and flexor hallucal brevis and the CSEP on bilateral posterior tibial nerve during the surgery of scoliosis.Forty -night of these patients received total intravenous anesthesia and the other 27 patients were anesthetized by propofol and sevoflurane (inhalant concentration <1%).The results of TES-MEP in both groups were analyzed by X2 analysis and related index about the true positive, false positive and true negative, false negative results were calculated.Results Success rates of TES-MEP and CSEP recording were both 96.1%.There was no statistics difference of the success rate of TES-MEP in the two different anesthesia groups.Evoked potentials changes occurred in 11 cases, in which 9 cases were true positive results in direct relation to an incorrect operative maneuver.The sensitivity of the CSEP, TES -MEP and muitimodality recording was 75.0%, 87.5% and 100%, respectively.The specificity of the three methods was 98.5%, 98.5% and 97.0%, respectively.The Youden index of the three methods was 0.74, 0.86 and 0.97, respectively.Conclusion The anesthesia by intravenous propofol and sevoflurane (inhalant concentration <1%) was a feasible method for muitimodality recording.The sensitivity and precision of muitimodality recording for detecting spinal cord function were apparently higher than that of unitary TES-MEP or CSEP monitoring.